Dr S K Gupta
The disease which was described in 1907 by ALOIS ALZHEIMER’S which is more than 100 years of Alzheimer’s disease. It is a fatal form of Dementia which leads to Progressive loss of memory and cognition.
Since the World’s Population is aging. Improvement in health care in the past century have contributed to people living longer and healthier lives. However, this has also resulted in an increase in the number of people with non-communicable diseases, including Dementia. Current estimates indicate that around 50 million people worldwide are living with dementia. This number will double by 2030 & triple by 2050. Dementia does not just affect individuals only, but it also affects & changes the lives of family members. Dementia is a costly condition in its social, economic & health dimensions. Nearly 60% of the burden of Dementia is concentrated in low & middle-income countries & this is likely to increase in coming years.
The Human brain is most complex structure of our body which is responsible for each and every activity of our body happening automatically such as beating of heart, breathing & all other activities performed consciously. To perform these functions brain has 100 billion neurons and their 300 trillion connections almost like a master computer with so many different programmes. These connections are communicating with each other through Electrical & Chemical signals. It is this unique ability of brain which makes us to perform different functions like, walking, talking, thinking, reasoning and remembering & behave the way we do. Demetia literally means “Loss of ability to think”.
Every three seconds someone in the world develops Dementia. Incidence of dementia in the developing countries accounts for more than 50% of the global elderly population. By the year 2020 approximately 70% of the World’s elderly population will be in the developing countries and India accounting for more than 15% of them. In India, approximately more than 1 million cases are detected every year.
Dementia deprives us from all those attributes that make us human, our capacity for love, for planning and reasoning, for making and recalling memories and it happens due to loss or malfunctioning of neurons. Thus dementia is gradual irreversible decline of brain function which slowly interferes with a person’s ability to carry out tasks of normal daily living.
Dementia may be defined as a diffuse deterioration in the mental capacities, resulting from brain dysfunction; usually secondary to organic disease of the brain. It manifests itself primarily in thought, memory and intelligence and secondarily affects feeling and conduct which can be of sufficient severity to interfere with social and or occupational functioning.
Alzheimer’s disease is the most common cause of dementia in western countries with increasing incidence and have an immense social impact. Alzheimer’s dementia accounts for 60-70% all cases of dementia. In India it accounts for a sizeable percentage of all cases of dementia in old age. Alzheimer’s disease is more common in females and sometimes it may be seen in more than one member of a family.
The Brain Atrophies with age and which is inevitable, but these changes are mild and may not manifest, clinically. By contrast severe degrees of diffuse cerebral atrophy that evolve over a few years and invariably associated with dementia and the underlying pathologic changes in these cases most often prove to be those of Alzheimer’s disease.
The number of risk factors are associated with Alzheimer’s disease like:-
* Genetic factors
* Head Injury
* Parental age
* Vitamin deficiencies particularly Vitamin D
* Depression & Tension
Tension can shrink the hippocampus and trigger cognitive impairment to full blown dementia. Meditation, breathing exercises and other relaxation techniques can help to mitigates the effects of stress.
The patient with Alzheimer’s disease presents with memory disturbance – forgetfullness is the major symptom. Small day to day happenings are not remembered and which may be ignored. Appointments are forgotten and possession are misplaced. Questions are repeated again and again. Remote memory is preserved and recent is lost. Patient forget what breakfast he has taken, speech also gets affected – patients forgets to recall words, ultimately speech becomes difficult.
Faults in balancing the checkbook, mistakes in figuring the price of items and is unable to carry out simplest calculations. In some patients visospatial orientation becomes defective. The car cannot be parked at proper place. Unable to put on clothes properly and way to home is lost.
Late in the course of illness, the patients forgets how to use common objects and tools.
Disability or impairment of Judgement and reasoning occurs. Vocabulary becomes restricted and conversation rambling and repetitions, misuse of proper names and inability to formulate phrases or sentences occurs. There may be destruction of speech functions as a whole so that speech becomes increasingly meaningless and ends in a jargon.
Lastly patient has difficulty in walking and unsteadiness in gait and ultimately patient losses the ability to stand or walk, being forced to lie inert in bed and having to be fed and bathed and legs curl into a fixed posture of flexion & may pass urine in the clothes.
Depression with insomnia and anorexia also occurs in 5-8% if cases. Delusions and psychotic behavior increase with progression of Alzheimer disease and present in 30% of the patients.
Agitation may coexist in upto 20% of cases. Hallucinations occur with similar frequency which may be visual or auditory.
The symptomatic course of this tragic illness usually extends over a period of 5 years or more.
Diagnosis of the disease is made by history, clinical findings, Blood tests, CT Scan , MRI Imaging and PET Scan of the brain.
As on date there is not much treatment for dementia. Therefore it is important to decrease the impact of disease by reducing the aggravating factors of course the patients are helped by early detection of the disease, exercise, good diet, vitamins and other neuroprotective drugs.
WAYS TO REDUCE THE RISK
No matter what your age or stage of life, is you have power to change many variables that influences your brain health. Following habits incorporated early may help to live longer with better brains:
* Mental Exercise: – Build physical and mental activities into everyday – Exercise halts dementia gene from being expressed and keeps your brain healthy. Moderate exercise may be single most effective way to prevent dementia.
* Eat Healthy:- Whole grains, fruits and vegetables, nuts and unsaturated fats. Also research has found turmeric and coconut oil to be protective and may even help new brain cell growth.
* Maintain healthy weight and body shape. Always treat your chronic diseases like high blood pressure, high blood sugar, and abnormal lipids with your doctor’s help.
* Don’t smoke:
* Challenge your mind:- Putting off retirements cuts chances of dementia. “USE IT OR LOOSE IT” Keeping the brain mentally challenged is one way to prevent dementia. Speaking more than one language also seems to help.
* Build a strong social network:- Have a positive mind-set ad purpose to live – Negative mindset and lack of purpose increases risk of dementia.
Alzheimer disease requires a multidisciplinary approach under the expertise of Neurologist, Psychiatrist, Clinical Psychologist, Physiotherapist, Acupational therapist and Primary care providers.
The theme of Alzheimer’s day is “No time to lose” as the number of people with dementia around the world is set to double over the next 25 years. The people with dementia and their carers to join the programmes to focus the attention of the Government and Non-Government sector on this neglected area of public health. The message is targeted to people with Dementia, their family members to take care of the diseased persons give them good family support, never neglect them, give them good diet and sit and talk with them time to time, also keep them busy in day to day activities.
Considering the severity of the illness and burden to the society let us come forward to be more aware about the disease and help the elderly population, who are at great risk of this serious illness by making the disease more understandable to common man in the society.
(The author is a Neurologist )
Dr S K Gupta